1
Q
what is the abdominal esophagus
A
- is one continuous muscular tube extending from the pharynx to the stomach
2
Q
what can the abdominal esophagus divided into
A
- cervical (head/neck)
- thoracic
- abdominal
3
Q
what is the length of the abdominal esophagus
A
short (1-2.5 cm) in length beginning at the esophageal hiatus (T10) of the diaphagm and terminating at the stomach
4
Q
where is the lower esophageal sphincter
A
- distal end of the esophageal, between the abdominal esophagus and the stomach
5
Q
what is the lower esophageal sphincter
A
- smooth musclular “gateway”, the lower esophageal sphincter (LES)
6
Q
what does the LES do?
A
prevent reflex of gastric content (acid, pepsin, etc.) into the esophagus
- INVOLUNTARY control, opening and closing as a bolus passes from the esophagus into the stomach
7
Q
gastroesophageal reflux (GERD)
A
- a weak or abnormal closure of the LES can result in regurgitation of stomach contents into the esophagus
- the reflux of the corrosive stomach contents into the esophagus is experienced as a buring sensation
- because its close to the heart buring is felt as “heartburn”
8
Q
symptoms of gastroesopheal reflux
A
- chest pain
- nausea
- and/or vomiting of reflux content
9
Q
anatomy of the stomach
A
once the bolus has passed the lower esophageal sphincter (LES), the bolus enters the stomach
- the rugae (gastric fold) of the stomach allows expansion, accommodating the quantity of consumed foods
10
Q
where is the pyloric sphincter
A
distal end of the stomach, where the stomach contents are emptied into the proximal part of the small intestines, the stomach walls narrow to form the pyloric orifice
11
Q
analogous to the LES
A
the pylorus has a “gateway”, the pyloric sphincter,
12
Q
what does the pyloric sphincter do
A
controls the movement of content from the stomach (chyme) into the duodenum
- under autonomic control
13
Q
what is an endoscopy
A
is the insetion of a long, thin tube directly into the body to observe an internal organ in detail
14
Q
what supplies blood to stomach
A
- celiac truck–> right and left gastric arteries which anastomose at the lesser curvature
- the right and left gastro-epiploic arteries anastomose at the greater curvature of the stomach
15
Q
what supplies the lesser curvature
A
right and left gastric arteries
16
Q
what supplies the greater curvature
A
right and left gastro-epiploic arteries
17
Q
where are the small intestine
A
extends from the pyloric orifice to the ileocecal junction
18
Q
what is the small intestine divided into
A
- duodenum
- jejunum
- ileum
19
Q
is the small intestine intraperitonela or retroperitoneal
A
most of it is intra except proximal part of the duodenum which retro
20
Q
what is the shortest part of the small intestine
A
duodenum which runs from the pyloric orifice to the jejunum
21
Q
what is the duodenum divided into?
A
- superior (first part)
- descending (second part)
- horizontal (third part)
- ascending (fourth part)
22
Q
superior part of the duodenum
A
is the only portion of the duodenum that is intraperitoneal
23
Q
what travels posterior of the superior part of the duodenum
A
bile duct and the gastroduodenal artery
24
Q
descending (second part) of duodemun
A
runs vertically, passing anterior to the hilum of the right kidney
25
what does the descending second part contain
major duodenal papilla, which is the site where the hepatopancreatic ampulla drains into the duodenum
26
what is the hepatopancreatic ampulla
duct formed from the union of the common bile duct and the pancreatic duct
27
horizontal part of duodeum
- transversely across the inferior vena cava and abdominal aorta, just inferior to the origin of the superior mesenteric artery and vein
28
what is superior mesenteric artery syndrome
compression of the duodenum between the aorta and the superior mesenteric artery
29
ascending fourth part of the duodenum
- passes upward and to the left of the aorta, forming the duodenojejunal flexure
30
duodenojejunal flexure
anchored to the posterior abdominal wall by the fibromuscular suspensory ligament of the duodenum ligament of Treitz
31
ligament of treitz shortened
is shortened, compression of the horizontal section of the duodenum can result
- another cause for superior mesenteric artery syndrome
32
duodenum blood supply 1st and 2nd parts
supplied by gastroduodenal artery and its branch --> superior pancreaticoduodenal artery
33
duodenum blood supply 3rd and 4th part
supplied by the inferior pancreaticoduodenal artery branch of SMA
34
jejunum and ileum blood supply
supplied jejunal and ileal arteries, branches of the SMA
- both arteries form a series of anastomotic loops (arterial arcades) from which terminal straight branches (vasa recta) reach the intestinal wall
35
networks that supply the jejunum have ___ arcades along with ___ vasa recta
fewer, longer
36
networks that supply ilium have ____ arcades with ____ vasa recta
many, shorter
37
what is meckels diverticulum
- outpouching of tissue in the distal ileum of the small intestine
- sudden abdominal pain or asymptomatic
- blood in the stool
38
what is primary function of the small intestine
absorption
39
outpouching
a bulging of the walls of the intestine to form a sac
40
about meckels diverticulum
- birth defect
- can become ulcerated, causing blood in the stool, and the pain confused with the pain from appendicitis
- can cause intestinal obstruction resulting in vomiting and constipation
41
pain with meckels diverticulum
is referred to the epigastric and umbilical regions of the abdomen
42
features in the large intestine
- teniae coli
- haustra
- epiploic (omental) appendages
43
teniae coli
- three thickened bands of longitudinal muscle
44
haustra
segmented pouches or folds
45
epiploic (omental) appendages
fatty tags enclosed by peritoneum
46
Hirschsprung disease
disorder that occurs at birth when motor nerve cells, called the Auerbach's plexus are absent in the muscles of the colon
- affect the colon making it difficult to pass stool
47
where does the ileum join the large intestines
at the cecum in the right inguinal region (lower right quadrant)
48
what is the opeing of the ileum into the cecum controlled by
ileocecal (ileocolic) valve
49
what is the cecum
is a blind-ended pouch lying in the right iliac regions (lower right quadrant) and is almost completely covered with peritoneum but has not mesentery (intraperitoneal structure)
50
intraperitoneal large intestines
- cecum
- transverse colon
- sigmoid colon
51
retroperitoneal of large intestine
- ascending colon
- descending colon
- rectum
52
what is the midgut portion of the large intestine supplied by
3 branches of the superior mesenteric artery
- ileocolic artery
- right colic artery
- middle colic artery
53
midgut ileocolic artery supplies what
ileocolic artery cecum to appendix)
54
midgut right colic artery supplies what
right colic artery (to ascending colon)
55
midgut middle colic artery supplies what
middle colic artery (to transverse colon)
56
what is the hindgut of the large intestine supplied by
branches of the inferior mesenteric artery
- left colic artery
- sigmoidal artery
- rectal artery
57
hindgut left colic artery supplies what
to descending colon
58
hindgut sigmoidal arteries supplies what
sigmoid colon
59
superior rectal supplies what of hindgut
rectum and upper anal canal
60
what forms the marginal artery
right, middle, left colic arteries
61
where does the marginal artery form
along the border of the colon that may allow important collateral circulation
62
mesenteric artery ischemia
is a condition resulting in the occlusion of the mesenteric arteries
63
effects of mesenteric artery ischemia
- midgut affects
- distal duodenum, jejunum, ileum, and colon
- leading to tissue death: thus small intestines cannot function normally and bowel movements become disruptied, leading to nausea and vomiting
64
abdominal pain of mesenteric artery ischemia
typically abrupt and accompanied by abdominal tendernes
65
what does the venous drainage of the abdomen form
an elaborate plexus of veins to return deoxygenated blood to the heart
66
what are the 3 main veins that drain the gastrointestinal viscera
1. splenic vein
2. superior mesenteric vein
3. inferior mesenteric vein
67
where do the splenic vein, SMV, or IMV drain to?
portal (hepatic portal) vein
68
where does the splenic vein leave?
the spleen
69
where does the splenic vein go
passes posterior to the pancreas to join the superior mesenteric vein
70
what does the splenic vein drain?
spleen, lower esophagus, and part of the stomach and pancreas
71
since the proximity of splenic vein to the pancreas what happens
various pancreatic conditions (tumors, infections) can compress the vein, leading to the formation of a thrombosis
72
thrombosis
the formation of blood clot preventing blood from flowing normally within the circulatory system
73
where does the superior mesenteric vein ascend
through the mesentery of the small intestine
74
what does the SMV join
the splenic vein, posterior to the pancreas
75
the names of the SMV tributaries (branches)
correspond to the branches of the superior mesenteric artery
76
what is the mesenteric ischemia
is the occlusion of the superior of the inferior mesenteric vein, it is rare, it can be fatal due to the many veins it drains
77
inferior mesenteric vein where does it ascend
on the left
78
what does the IMV join
the splenic vein
79
IMV tributes (branches)
correspond to the branches of the IMA
80
what is mesenteric ischemia
results from the occlusion of the superior or inferior mesenteric vein
81
what is more common in the SMV
mesenteric ischemia
82
what does the hepatic portal vein do
carriers nutrient-rich deoxygenated blood from the digestive tract to the liver
83
where is the hepatic portal vein formed
posterior to the pancreas
84
how is the hepatic portal vein formed
by the union of the splenic and superior mesenteric veins
85
where does the portal vein ascend
before entering the porta hepatis of the liver
86
what is assessment of pulsatiliilty (rate of blow flow) of the portal vein used for
detecting early signs of cirrhosis
87
porta hepatis
the porta hepatis is a deep fissure in the inferior surface of the liver through which neurovascular structures enter or leave the liver
88
cirrhosis
a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue
- typically result of alcoholism or hepatitis
89
what is mesenteric ischemia
the partical or complete interruption of blood in the superior or inferior mesenteric artery resulting in abnormal bowel movements, abdominal pain, vomiting
90
what is the best imaging technique to diagnose mesenteric ischemai
angiography
- as it is used to image the lumen of the vasculature
- helps see the blockage
91
necrosis
the death of most or all of the cells in an organ or tissue due to disease, injury or failure of the blood supply
92
about the liver
- is the largest internal organ in the body
- right and central upper abdomen
93
inferior surface of the liver
is adjacent to abdominal viscera
94
what are lobes of the liver divided by
the attachment of a fold of peritoneum
- falciform ligament
95
what is the peritoneal cavity incompletely divided into
spaces and recesses (or fossae)
96
what do the spaces and recessus important for
allow passage for infectious fluids from different compartments of the abdomen
97
what are the 2 liver recesses
- subphrenic recess
- hepatorenal recess
98
subphrenic recess
are superior extensions of the peritoneal cavity between the liver and diaphragm
99
how many subprenic recesses are there
left and right
100
what are the left and right subphrenic recess separated from
falciform ligament of the liver
101
what is hepatorenal recess
is a deep recess in the peritoneal cavity on the right side between the liver and the right kidney
102
how much cardiac output passes through the liver?
one third
103
how does cardiac output pass through the liver
delievered through the portal vein and 20% is delivered via the hepatic artery proper
104
portal vein thrombosis : what is it
a blood clot is formed in the portal vein
- an occlusion in this vessel interrupts the flow of nutrient rich blood from the intestines to the liver
105
symptoms of portal vein thrombosis
upper right abdominal pain, abdominal swelling, fever
106
what does the gallbladder do?
receives, stores, and concentrates bile
107
where is the fundus of the gallbladder
projects anteriorly from the inferior border of the liver
- the body projects posteriorly and narrows to the neck which is continuous with the cystic duct
108
gallstones
are hardened deposits of bile that can form in the gallbladder
- biliary colic is spasmodic pain caused by an attempt to expel a gallstone
109
when do gallstones cause pain?
when they obstruct the biliary ducts
110
what is the biliary tree
the system of vessels that directs secretions from the liver, gallbladder, and pancreas through a series of ducts into the duodenum
111
cholangitis
is an inflammatory condition of the biliary duct system, commonly caused by gallstones blocking a duct
- bile is sterile but due to the presence of gallstones, bacteria enters the biliary tree by a reverse ascent from the duodenum
112
symptoms of cholangitis
- pain in the right upper quadrant of the abdomen
- fever
- chills
- nausea
- vomiting
113
what causes the blockage of the biliary duct system
presence of bacteria causes a block in the passageways leading to infection
- increased biliary pressure further spreads the infection into the hepatic veins leading to bacteremia
114
bacteremia
presence of bacteria in the bloodstream
115
location of the pancreas
lies transversely on the posterior abdominal wall, posterior to the stomach
116
location of head of pancreas
sits in the concavity of the duodenum on the right side of the abdominal cavity
- has a medial projection, the uncinate process, lying deep to the superior mesenteric vessls and the origin of the portal vein
117
location of the body pancreas
extends towards the left, passing behind the stomach and tapering to become the tail
118
location of the tail of pancreas
abuts the medial side of the spleen
119
what is pancreatitis
inflammation of the pancreas, can be caused by the presence of gallstones
120
when do gallstones become problematic
when they block the common bile duct
- pancreatic enzymes are also blocked passing into the small intestine, forceing them into the pancreas
121
pancreatitis : recycled enzymes
begin to irritate the cells of the pancreas causing the inflammation associated with pancreatitis
122
symptoms of pancreatitis
- upper abdominal pain
- upper left quadrant pain
- nausea/vomiting
- fever
123
location of the spleen
- left upper quadrant of the abdomen
- under the left dome of the diaphragm behind the stomach and anterior to ribs 9, 10, 11
124
what is the largest lymphatic organ
spleen
125
notches on the spleen
- are on the anterior border
126
what is on the medial surface of spleen
hilum (can be papated if swollen)
127
what enters and exits the hilum of spleen
- splenic artery
- splenic vein
128
splenomegaly
- since spleen is on the left side pain with splenomegaly is also felt in the left upper abdomen
129
where is pain felt with gallstones
is felt on the right, since the gallbladder sits in the right upper abdomen
130
what is a common cause of splenomegaly
liver disease
131
jaundice
- skin, whites of eyes, and mucous membranes turn yellow because of a high level of bilirubin resulting from a dysfunctional liver
132
relationships with the pancreas
- nestles its head into the arms of the duodenum
- the tail of the pancreas (left) is playing footsies with the spleen
133
relationships with the common bile duct
- passes through duodenum
- proximal to the pancreas
134
what are earliest signs of a tumor in the head of the pancreas
pain associated with the gallbladder because its compressed
135
relationships with the duodenum
- vessels of the superior mesenteric artery and abdominal aorta
- duodenum is "sandwiched between the two at one point
136
relationships with the liver
- inferior to the diaphragm
- bare surface of the liver touches the diaphragm
- right dome of the diaphragm is higher than the left dome to accommodate the size of the liver
137
where are the kidneys located
on the posterior abdominal wall on either side of the vertebral column
138
what kidney is lower, why?
right kidney
- due to the position of the liver which lies superior to it
139
what is posterior to the kidney
diaphragm as well as the costco diaphragmatic recesses of the pleural cavitiies
140
how much do the contraction of the diaphragm move the kidneys
downward 2.5cm
141
pyelonephritis
- kidney infection typically caused by a bacterial infection of the bladder
- infections from the bladder can travel to the kidney through the ureters
142
acute pyelonephritis
is one of the most common bacterial infection in young adult women
143
symptoms of pyelonephritis
- flank pain
- fever
144
flank pain
is a sensation of discomfort, distress, or agnoy in the upper abdomen or back and sides
- this is the region between the hip bone (iliac bone) and lower rib cage
145
what can diagnose pyelonephritis
urinalysis
146
urinalysis
is a group of physical, chemical, microscopic tests
- tests detect and/or measure several substance in the urine, such as byproducts of normal and abnormal metabolism, cells, cellular fragments, bacteria
147
what are ureters
muscular tubes that transport urine from the kidney to the bladder
148
where does the ureter leave
the hilum of the kidney and descends vertically towards the pelvis
- during its descent, it passes anterior to the psoas muscle and the bifurcation of the common iliac artery and vein
149
ureter stones what is it
also known as a ureteral stone, is a kidney stone that has moved from the kidney into another part of the urinary tract, obstructing the pathway of urine from the kidney to the bladder
150
symptoms of ureter stones
- severe, intermittent pain in the flank region
- damage to the ureters can be detected as blood in the urine and pain when urinating
- fever
- nausea
- vomiting
151
passing of the ureter stones
stones may pass through the ureter, into the bladder, and eventually pass out of the body during urination
152
too big of a stone
can get lodged in the ureter, block flow of urine and can be extremely painful
153
where are the adrenal glands
lie on the upper poles of the kidneys
154
shape of the right adrenal gland
is pyramidal
155
shape of the left adrenal gland
is semilunar
156
what are the suprarenal gland supplied by
the suprarenal artery as well as branches from the inferior phrenic and renal arteries
157
adrenal gland tumor
pain associated with an adrenal gland tumor would be felt more superiorly relative to pain from pyelonephritis or a ureter stone
158
symptoms of adrenal gland tumor
will indicate an imbalance/overproduction of hormones which can result in excessive hair growth and unusual acne
159
blood supply of kidneys
- receive blood from the right and left renal arteries (off the abdominal aorta) and 2nd lumbar vertebra
160
accessory renal arteries
- common and may arise from the aorta above or below the main renal artery and enter the kidney above or below the hilum
161
where do the right and left renal veins travel
anterior to the renal arteries
162
where does the left renal vein pass
under the SMA to drain into the INC
163
what renal vein is longer and why
left because it has to cross the aorta to reach the IVC
164
what is nutcracker syndrome
rare condition that occurs when the left renal vein becomes compressed between the abdominal aorta and the superior mesenteric artery
165
symptoms of nutcracker syndrome
pressure increase in the renal vein can lead to blood and protein appearing in the urine
- flank pain
- abdominal pain
166
what is the first course of action against acute pyelonephritis
antibiotics
- the type depends on whether or not the bacteria can be identific
ANAT 380
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